UCLA CENTER FOR
HEALTH POLICY RESEARCH .

Health Policy Fact Sheet

May 2021

 

Disaggregating California's COVID-19
Data for Native Hawaiians and Pacific

Islanders and Asians

Ninez A. Ponce, Riti Shimkhada, and 'Alisi Tulua

he toll of COVID-19 on smaller

communities within broad racial/
ethnic categories has been exposed in media
reports, health worker memorials, and data
collected by special interest groups. However,
in many public-facing data systems, the
Native Hawaiian and Pacific Islander (NHPI)
and Asian categories are grouped or may not
even be reported.

California is home to the largest single-race
NHPI and Asian population compared to
other states,' and about 57% of all NHPIs
have settled into three states: California (25%),
Hawaii (24%), and Washington (8%). About
48% of all Asians in the U.S. have settled into
three states: California (31%), New York (9%),
and Texas (8%). Given California's large NHPI
and Asian populations and the diversity of the
groups, analysis of the state's COVID-19 data
offers an opportunity to examine disaggregated
data and highlight the challenges of
aggregated information in exposing the toll

of COVID-19 on smaller NHPI and Asian

communities.

Methods

We obtained data from the California
Comprehensive Death File (Dynamic) on
all COVID-19 mortality in 2020 from the
California Department of Public Health
on NHPI and Asian subgroups, extracted
on Jan. 27, 2021, after submitting a table

request for this restricted data. This data
chronicles California's loss of 177 NHPI
and 3,835 Asian lives to COVID-19 in
2020 (single-race, non-Hispanic Asian and
NHPI). We estimated Asian subgroup
proportions within the aggregate Asian
category and NHPI subgroup proportions
within the NHPI group using the
one-year 2019 American Community
Survey (ACS) data, and then applied the
distributions of subgroups within the
Asian and NHPI categories to California
Department of Finance 2020 Population
Estimates. These population estimates
were used as denominators to calculate
crude mortality rates (number of deaths
per 100,000 population).

Results

In 2020, the state of California's crude
mortality rate due to COVID-19 was

84 per 100,000 population. The crude
mortality rates for the Asian and NHPI
combined group was 75 per 100,000
compared to the 123 per 100,000 for
NHPIs and 74 per 100,000 for Asians.
The Asian aggregate crude mortality rate
was lower than the state rate, but the
NHPI aggregate rate was much higher
than the state rate and for the other major
racial/ethnic groups.' If the state were to
have reported COVID-19 deaths in an
Asian and NHPI category, as is currently

 

 
 

 

2 UCLA CENTER FOR HEALTH POLICY RESEARCH

practiced in eight states,' then policymakers
would deem NHPIs to have a lower risk on
average than the state's population.

Within the separate NHPI categories,
aggregation still masks the variation in
mottality across the subgroups. In Exhibit 1,
death rates per 100,000 are higher for the

Samoan subgroup (182 per 100,000)
compared to the aggregated NHPI
category wherein COVID-19 mortality
was 123 per 100,000. The NHPI
aggregate is also driven by high mortality
rates among Tongans (124 per 100,000)
and Chamorros or Guamanians (107 per
100,000).

 

Exhibit 1 California COVID-19 Crude Mortality Rate (Deaths per 100,000) for Non-Latino
Single-Race NHPIs, All Ages, Jan. 1, 2020--Dec. 31, 2020
Death rates State Total

per 100,000
ave higher for

Asian & NHPI

the Samoan All NHP|
subgroup camoan
compared to

Tongan

the aggregated
NHPI

category.

Chamorro/Guamanian

Native Hawaiian

Fijian

182

 

* <11 deaths

Data Source: For numerator: California Department of Public
Health, California Comprehensive Death File (Dynamic),
2020. Date extracted: Jan. 27, 2021. Tabular Request; For
denominator: American Community Survey 2019 1-year
estimated NHPI subgroup proportions applied to California

 

100 150 200

Department of Finance 2020 Population Estimates for the
NHPI population. State Population Death Rates from the
NCHS/CDC Provisional Death Counts for Coronavirus Disease
(COVID-19): Distribution of Deaths by Race and Hispanic
Origin, accessed May 5, 2021.

 

 
 

 

3 UCLA CENTER FOR HEALTH POLICY RESEARCH

 

For Asians, there are seven Asian subgroups rates that are more than 1.5 times that of
with mortality higher than the Asian the aggregate. (Exhibit 2).
aggregate rate, with some groups having

 

Exhibit 2 California COVID-19 Crude Mortality Rate (Deaths per 100,000) for Non-Latino
Single-Race Asians, All Ages, Jan. 1, 2020--Dec. 31, 2020

There are State Total 84
SCVEN As 1an Asian & NHPI 75
subgroups All Asian 74
with mortality
higher than
the Asian
aggregate vate.

Japanese 119

Cambodian 114

Filipino 107

Korean 101

Laotian 93

Hmong 87

Indonesian 79

Vietnamese 74

ul
<e)

Thai
Bangladeshi 59*
Chinese 54

Pakistani 48
Burmese 46*
Taiwanese 41
Asian Indian 24

Other South Asian 19*

 

 

o-
No
o
oy
Oo
oO
o

80 100 120

* <11 deaths

Data Source: For numerator: California Department of Public population. State Population Death Rates from the NCHS/
Health, California Comprehensive Death File (Dynamic), CDC Provisional Death Counts for Coronavirus Disease
2020. Date extracted: Jan. 27, 2021. Tabular Request; for (COVID-19): Distribution of Deaths by Race and Hispanic
denominator: American Community Survey 2019 1-year Origin, accessed May 5, 2021. Other South Asian races
estimated Asian subgroup proportions applied to California includes Nepalese and Sri Lankan.

Department of Finance 2020 Population Estimates for the Asian

 

 
 

 

UCLA CENTER FOR HEALTH POLICY RESEARCH

Conclusions

* Compared to overall state estimates of
84 COVID-19 deaths per 100,000, the
Asian category death rates are lower. In
our disaggregated analysis, seven Asian
groups exceeded the aggregate Asian and
state averages. NHPI deaths per 100,000
exceeded the state average and the Asian and
NHPI combined average. Among NHPI
groups, Samoans experienced death rates
much higher than the other NHPI groups.

¢ California follows the U.S. Office of
Management and Budget (OMB)
guidelines in disaggregating Asians from
NHPIs. However, only 23 states currently
report on NHPI COVID-19 mortality
statistics, with the majority of states
aggregating Asians with NHPIs, or not
reporting on NHPIs at all. As seen in
Exhibits 1 and 2, this aggregation does not
measurably change the rate of COVID-19
death rates for Asians but is a substantial
underestimate of the NHPI COVID-19
mortality rate.

e The decision to balance reporting the
most granular data as possible with
concerns with disclosure risk and statistical
reliability can be addressed by creating
intermediate aggregate categories. For the
Asian analyses, we created an "Other South
Asian category" to distinguish two groups
- Nepalis and Sri Lankans. Similarly,
NHPI data could have intermediate
categories of Other Micronesian, Other
Polynesian, and Other Melanesian.

We found that the lack of disaggregated
data has hidden the needs of smaller
subpopulations who suffered
disproportionately from COVID-19.
These groups tend to be those who also
face sociodemographic stressors that make
them vulnerable to poor health outcomes.
Collecting and disaggregating Asian

and NHPI COVID-19 data detects the
risks and unmet need in these smaller
communities. With this evidence, policy
resources can be more precisely targeted
and policy neglect avoided owing to the
invisibility of populations in aggregated
data.

Technical Notes

The threshold for data suppression varies
in different public health data systems. In
examining the California Comprehensive
Death File data, we made decisions in
optimizing reporting the maximum
number of subgroups with a reasonable
threshold for mitigating disclosure risk
and stability of estimates. We arrived at
aggregating categories with fewer than
seven deaths to mitigate disclosure risk
and increase reliability of reported per
capita death rates. To acknowledge the
California State Department of Public
Health suppression rules of not reporting
deaths fewer than 11 incidents, we
distinguish those estimates in our results.

 

 
 

 

UCLA CENTER FOR HEALTH POLICY RESEARCH

Author Information

Ninez A. Ponce, PhD, MPP, is the director of

the UCLA Center for Health Policy Research,
principal investigator of its Native Hawaiian and
Pacific Islander Data Policy Lab, and a professor

at the UCLA Fielding School of Public Health.
Riti Shimkhada, PhD, MPH, is a senior research
scientist at UCLA CHPR. 'Alisi Tulua is the
project director of the Native Hawaiian and Pacific
Islander Data Policy Lab.

 

Acknowledgments

The authors would like to thank Loraine Escobedo,
PhD, from the Cedars-Sinai Cancer Research
Center for Health Equity, and Vananh Tran,
Richard Calvin Chang, Corina Penaia, Karla
Thomas, and Brittany Morey from the Native
Hawaiian and Pacific Islander Data Policy Lab for
their contributions.

Suggested Citation

Ponce NA, Shimkhada R, Tulua A. 2021.
Disaggregating California's COVID-19 Data for
Native Hawaiians and Pacific Islanders and Asians.
Los Angeles, CA: UCLA Center for Health Policy

Research.

Endnotes

1 U.S. Census Bureau. American Community Survey
(ACS), 2019 Census Tables: DP05, 2019, ACS 1-Year
File.

2 The Native Hawaiian and Pacific Islander COVID-19

Data Policy Lab Dashboard. UCLA Center for Health
Policy Research. 2020. brtps://healthpolicy.ucla.edul
bealth-profiles/Pages/NHP1-COVID-19-Dashboard.aspx

3 The COVID Tracking Project. The Atlantic. 2020.
bttps:/lcovidtracking.com/raceldashboard

 

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